What Is Metastatic Prostate Cancer

What Is A Common Site Of Prostate Carcinoma

A bone site accounted for 84% of the cases, and a distant lymph node for 10%. The liver has a prevalence of 10%, while the lungs have a prevalence of 6%. The percentage of thorax is higher than the percentage of cancers . 1%). A total of 18 points. A total of 4% of patients had multiple metastatic sites. Only 19 patients are stratified according to the site of metastases when they are grouped by their location. A total of 4% of men with bone metastases had multiple sites.

Treatment By Stage Of Prostate Cancer

Different treatments may be recommended for each stage of prostate cancer. Your doctor will recommend a specific treatment plan for you based on the cancers stage and other factors. Detailed descriptions of each type of treatment are provided earlier on this same page. Clinical trials may also be a treatment option for each stage.

Early-stage prostate cancer

Early-stage prostate cancer usually grows very slowly and may take years to cause any symptoms or other health problems, if it ever does at all. As a result, active surveillance or watchful waiting may be recommended. Radiation therapy or surgery may also be suggested, as well as treatment in clinical trials. For those with a higher Gleason score, the cancer may be faster growing, so radical prostatectomy and radiation therapy are often recommended. Your doctor will consider your age and general health before recommending a treatment plan.

ASCO, the American Urological Association, American Society of Radiation Oncology, and the Society of Urologic Oncology recommend that patients with high-risk early-stage prostate cancer that has not spread to other areas of the body should receive radical prostatectomy or radiation therapy with hormonal therapy as standard treatment options.

Locally advanced prostate cancer

Watchful waiting may be considered for older adults who are not expected to live for a long time and whose cancer is not causing symptoms or for those who have another, more serious illness.

How To Tell If Your Cancer Has Metastasized

Prostate cancer metastasis may be suspected if you have specific symptoms such as new lower back pain or elevated liver enzymes. These may be signs your cancer has spread to your spine or your liver, respectively. If your prostate-specific antigen levels continue to rise despite treatment, especially if they are rising particularly fast, this may be a sign that cancer is metastasizing somewhere in your body.

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Bone Loss From Prostate Cancer Treatment

Testosterone, the male sex hormone, fuels the growth of prostate cancer but it also is crucial to bone health. Treatment of prostate cancer with hormone therapy, also called androgen deprivation therapy , blocks the production of testosterone which stops or slows the growth of the cancer. Without testosterone, bones can become weak and break more easily. When a man is on ADT recovery from a bone fracture takes longer than for other men. It is especially important for men taking ADT to speak with their physician about how to plan for and manage the bone loss before a problem arises. Bone strength can also be decreased as a result of radiation and chemotherapy used to treat prostate cancer.

Fortunately there are ways to strengthen and repair your bones including medicines and lifestyle changes.

• Bisphosphonates can prevent the thinning of the bone and help make them stronger
• Oral bisphosphonates include Fosamax and Actonel
• The intravenous bisphosphonate is Zometa
• Strive for a healthy diet and make sure to get enough calcium and vitamin D
• When exercising, include weight bearing and muscle strengthening exercises
• Avoid tobacco and excessive alcohol

Learn

What Are The Symptoms Of Metastatic Prostate Cancer

Symptoms of metastatic prostate cancer vary depending on where the secondary cancer develops. Up to 90% of the time, prostate cancer spreads to bones. Bone mets often form in the ribs, spine, pelvis, arms, and legs.

Bone mets can cause chronic pain in the affected area, as well as bone fractures and spinal compressions. You may experience:

• arthritis-like pain

• difficulty passing urine or stool

• fatigue

• numbness or weakness

• pain that worsens or doesnt get better when resting

Bone mets can also raise blood calcium to dangerous levels. Too much calcium in the blood can affect brain and heart function. You may feel confused, lethargic, or experience heart palpitations.

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Improving How Long Patients Live

The ENZAMET trialfunded in part by the drugs manufacturer, Astellas Pharma, as well as government health agencies in Canada and Australiaenrolled more than 1,100 men with hormone-sensitive metastatic prostate cancer. The men were randomly assigned to ADT combined with enzalutamide or with any of three other androgen-blocking drugs.

At a median follow-up of nearly 3 years, men who received ADT plus enzalutamide had a 33% reduced risk of death, with 80% still alive compared with 72% of men treated with ADT plus another antiandrogen drug, reported the trials lead investigator, Christopher Sweeney, M.B.B.S., of the Dana-Farber Cancer Institute.

Men in the enzalutamide group also had better clinical progression-free survival , which the research team defined as the time until the return of disease-related symptoms, the detection of new metastases on imaging scans, or the initiation of another cancer treatment for prostate cancer, whichever came first. At 3 years, 63% of men in the enzalutamide group were alive without clinical progression of their disease, compared with 33% in the standard treatment group.

Although enzalutamide appeared to be effective regardless of whether men had high- or low-volume disease, one apparent differentiating factor was planned early treatment with docetaxel. Nearly half of the men in both treatment groups received early treatment with docetaxel and, for those men, enzalutamide was not associated with longer overall survival.

Cdc Warns Incidence Of Metastatic Prostate Cancer On The Rise

Jason M. BroderickUrology Times Journal

Although the overall incidence of prostate cancer has declined, the percentage of patients with metastatic disease at diagnosis has increased over the last decade.

Over the past decade, the incidence of metastatic prostate cancer in the United States has been on the rise, according to an analysis published in the Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report.1

Between 2003 and 2017, the percentage of patients diagnosed with metastatic prostate cancer increased from 4% to 8%. This increase occurred even though the overall age-adjusted incidence of prostate cancer in the United States went down from 155 per 100,000 in 2003, to 105 per 100,000 in 2017.

Although approximately three-fourths of US men with prostate cancer have localized stage at diagnosis, an increasing number and percentage of men have received diagnoses of distant stage prostate cancer. Survival with distant stage prostate cancer has improved, but fewer than one-third of men survive 5 years after diagnosis, the investigators wrote.

Of note, when comparing 5-year relative survival for the periods of 2001-2005 and 2011-2016, the rate improved from 28.7% to 32.3% in patients with metastatic disease. The authors suggested that the improvement might be attributed to recent advances in the prostate cancer armamentarium, including novel antibody and hormone treatments.

Reference

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Staging Of Prostate Cancer

• Stage I : The Gleason score is 6 or less, and the PSA level is less than 10. Cancer at this stage is normally not detectable in an ultrasound test or in a DRE test, as the tumor is very small. It is within the prostate and has not spread to nearby lymph nodes. It is usually discovered accidentally during a surgery carried out for another purpose. Prostate ultrasound and biopsy can be performed after detection of elevated blood PSA levels.
• Stage II : From this stage onwards, the Gleason score and the PSA level may vary from person to person. As the tumor grows in size, it can be detected in a DRE test or sonogram, but the tumor is still confined to the prostate gland. It is in one half or less of only one side of the prostate. It hasnt spread to lymph nodes and nearby organs, or it has spread to nearby lymph nodes, but has not invaded nearby organs.
• Stage III : The cancerous cells spread out from the original site and invade the seminal vesicles. They do not spread to nearby lymph nodes or to nearby organs in the body.
• Stage IV : The cancer moves out of the seminal vesicles and invades the lymph nodes. The size and number of tumors increase, and the cancerous cells spread into the nearby organs, such as the bladder and the rectum. In stage four prostate cancer, even bones and other parts of the body like lungs and liver are likely to be invaded by the cancerous cells.

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How Doctors Find Metastatic Prostate Cancer

When you are diagnosed with prostate cancer, your doctor will order tests such as:

• X-rays
• MRI scans
• PET scans

These tests may focus on your skeleton and in your belly and pelvic areas. That way doctors can check for signs that the cancer has spread.

If you have symptoms such as bone pain and broken bones for no reason, your doctor may order a bone scan. It can show if you have signs of cancer spread in your bones.

Your doctor will also ask for blood tests, including a check of PSA levels, to look for other signs that the cancer is spreading.

PSA is a protein made by the prostate gland. A rise in PSA is one of the first signs your cancer may be growing. But PSA levels can also be high without there being cancer, such as if you have an enlarged prostate a prostate infection, trauma to the perineum, or sexual activity can also cause PSA level to be high.

If you’ve been treated, especially if a surgeon removed your prostate, your PSA levels should start to go down. Doctors usually wait seve,ral weeks after surgery before checking PSA levels. A rise in PSA after treatment may suggest the possibility cancer is back or spreading. In that case, your doctor may order the same tests used to diagnose the original cancer, including a CT scan, MRI, or bone scan. The radiotracer Axumin could be used along with a PET scan to help detect and localize any recurrent cancer.

Though very rare, it’s possible to have metastatic prostate cancer without a higher-than-normal PSA level.

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In Five Years A Major Treatment Shift

In men diagnosed with metastatic hormone-sensitive prostate cancer, the cancer is typically driven to grow and spread by androgens that are produced largely in the testes. For many years, treatments that block androgen production have been a mainstay for men initially diagnosed with metastatic prostate cancer.

Starting in 2014, that began to change after a large clinical trial showed that adding the chemotherapy drug docetaxel to ADT improved how long men with hormone-responsive disease lived. Shortly after, another clinical trial showed that adding abiraterone to ADT also improved survival in these men, although primarily in men with many metastatic tumors, known as high-volume disease.

However, docetaxel, which works by directly killing cancer cells, can have substantial side effects, and some patients arent healthy enough to tolerate it. And abirateronewhich blocks androgen production throughout the bodycan also cause side effects, including those that affect the liver. It also has to be given in combination with the steroid prednisone, which carries its own toxicity.

Doing so, Dr. Chi said during a presentation of the TITAN data at the ASCO meeting, might help stave off the typically inevitable development of hormone-resistant cancer, which is more difficult to treat and a key driver of prostate cancer deaths.

Enzalutamide Improves Survival In Patients With Metastatic Prostate Cancer

Summary

In an international randomizedphase III clinical trial, the hormone therapy enzalutamide extended survival in men with metastatic prostate cancer that had progressed during treatment with androgen deprivation therapy. Participants in the trial had not received chemotherapy.

New England Journal of Medicine, June 1, 2014.

Background

Early in their development, prostate cancers need relatively high levels of male sex hormones to grow. The testes are the main source of androgens, and treatments that stop the testes from producing male sex hormonesknown as hormone therapy or androgen deprivation therapy are therefore a common treatment for androgen-sensitive prostate cancer. However, most prostate cancers eventually become castrate resistantthat is, they can grow even when androgen levels in the blood are very low. ADT does not block production of the small amount of androgen that is made by the adrenal glands and by prostate cancer cells themselves, and this low level is sufficient to fuel the growth of castrate-resistant prostate cancers.

Enzalutamide is among several hormone therapies that have been developed to prevent the androgen-fueled growth of castrate-resistant prostate cancers. This drug works by keeping androgens from binding to the androgen receptors on prostate cancer cells.

The Study

Men in the trial were randomly assigned to receive 160 mg of enzalutamide or a placebo taken orally once daily.

Results

• Posted:June 27, 2014

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Stage Iv Prostate Cancer Prognosis

Prostate cancers detected at the distant stage have an average five-year survival rate of 28 percent, which is much lower than local and regional cancers of the prostate. This average survival rate represents stage IV prostate cancers that have metastasized beyond nearby areas to lymph nodes, organs or bones in other parts of the body.

How We Treat Prostate Cancer

The prognosis for metastatic prostate cancer can be discouraging, but some treatment centerslike the Johns Hopkins Precision Medicine Center of Excellence for Prostate Cancerspecialize in innovative, individualized therapy with the potential to improve outcomes.

First Line Treatment For Advanced Prostate Cancer

The established first line approach is to control the progression of the disease by reducing levels of testosterone in the body. This is because testosterone increases the speed at which prostate cancer cells reproduce.

There are two different ways to lower testosterone levels. Hormone therapy lowers the levels of testosterone in the body by taking tablets or having injections. It is sometimes referred to as medical castration. The surgical option involves removing the testicles, known as surgical castration or orchidectomy, although this is now rarely used.

Another approach is called anti-androgen treatment. Androgens have to bind to a protein in the cell called an androgen receptor to work. Anti-androgens are drugs that bind to these receptors so the androgens cant, effectively blocking them. The main side-effects are gynaecomastia breast enlargement and breast pain, although a single radiotherapy dose to the breasts can help this side-effect.

Combining anti-androgens with testosterone reduction is known as Maximum Androgen Blockade and may be used if hormone treatment alone is not working sufficiently.

Treating with chemotherapy at the same time as the start of hormone deprivation was found to increase survival by 13 months in all patients and 17 months in men with high-volume disease.

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How Will My Cancer Be Monitored

Your doctor will talk to you about how often you should have check-ups. At some hospitals, you may not have many appointments at the hospital itself. Instead, you may talk to your doctor or nurse over the telephone. You might hear this called self-management.

You will have regular PSA tests. This is often a useful way to check how well your treatment is working. Youll also have regular blood tests to see whether your cancer is affecting other parts of your body, such as your liver, kidneys or bones.

You might have more scans to see how your cancer is responding to treatment and whether your cancer is spreading.

Your doctor or nurse will also ask you how youre feeling and if you have any symptoms, such as pain or tiredness. This will help them understand how youre responding to treatment and how to manage any symptoms. Let them know if you have any side effects from your treatment. There are usually ways to manage these.

Who Is At Risk For Advanced Prostate Cancer

The exact cause of prostate cancer isnt clear. Your risk of developing this particular cancer increases after you reach age 50.

Certain groups are more likely to develop aggressive forms of prostate cancer, including African-American men and men who carry certain inherited genetic mutations such as BRCA1, BRCA2, and HOXB13.

Most men with prostate cancer dont always have a family history of the disease. But having a father or brother with prostate cancer more than doubles your risk.

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What Is Advanced Prostate Cancer

Advanced prostate cancer is cancer that has spread from the prostate to other parts of the body. It develops when prostate cancer cells move through the blood stream or lymphatic system.

Watch our video about advanced prostate cancer.

You might hear cancer that has spread described as metastatic prostate cancer, secondary prostate cancer, secondaries, metastases or mets. It is still prostate cancer, wherever it is in the body.

Prostate cancer can spread to any part of the body, but most commonly to the bones and lymph nodes. Lymph nodes are part of your lymphatic system, which is part of the bodys immune system. Lymph nodes are found throughout the body including in the pelvic area, near the prostate.

Advanced prostate cancer can cause symptoms, such as fatigue , bone pain, and problems urinating.

The symptoms you have will depend on where the cancer has spread to. Speak to your doctor or nurse if you have any symptoms. There are treatments available to help manage them.

Its not possible to cure advanced prostate cancer. But treatments can help keep it under control and manage any symptoms.

Active Surveillance And Watchful Waiting

If prostate cancer is in an early stage, is growing slowly, and treating the cancer would cause more problems than the disease itself, a doctor may recommend active surveillance or watchful waiting.

Active surveillance. Prostate cancer treatments may seriously affect a person’s quality of life. These treatments can cause side effects, such as erectile dysfunction, which is when someone is unable to get and maintain an erection, and incontinence, which is when a person cannot control their urine flow or bowel function. In addition, many prostate cancers grow slowly and cause no symptoms or problems. For this reason, many people may consider delaying cancer treatment rather than starting treatment right away. This is called active surveillance. During active surveillance, the cancer is closely monitored for signs that it is worsening. If the cancer is found to be worsening, treatment will begin.

ASCO encourages the following testing schedule for active surveillance:

• A PSA test every 3 to 6 months

• A DRE at least once every year

• Another prostate biopsy within 6 to 12 months, then a biopsy at least every 2 to 5 years

Treatment should begin if the results of the tests done during active surveillance show signs of the cancer becoming more aggressive or spreading, if the cancer causes pain, or if the cancer blocks the urinary tract.

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